Provider Demographics
NPI:1881407948
Name:ORIOL, WILDJYMSON
Entity type:Individual
Prefix:DR
First Name:WILDJYMSON
Middle Name:
Last Name:ORIOL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 NW 58TH TER APT B3
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-3154
Mailing Address - Country:US
Mailing Address - Phone:954-225-9656
Mailing Address - Fax:
Practice Address - Street 1:2220 NW 58TH TER APT B3
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-3154
Practice Address - Country:US
Practice Address - Phone:954-225-9656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPA-2364363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant